Article: Expedited discharge and risk of readmission after ostomy construction
Year Published: February 2025
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Discuss the research question or main problem discussed in the study?
ReplyDeleteThis study aimed to evaluate the association between hospital readmissions after the surgical placement of a new ostomy, and the initial postoperative length of stay. With new medical advances, many patients discharge from the hospital within 2 days of ostomy placement. This shortened postoperative period could potentially lead to readmissions due to lack of support and education related to the care and maintenance of the patient’s new ostomy. The hypothesis is that patients with expedited discharge would inevitably have an increase in readmission rates during the first 30 day period with their new ostomy. There was an additional hypothesis that certain comorbidities/procedure types would be most associated with these expedited discharges analyzed.
Describe the method used by the author of the study
This study utilized a retrospective review to identify patients who received an ileostomy or colostomy via the 2019-2020 nation American College of Surgeons NAtional Safety and Quality Improvement Project. The study only included patients who were over 18 years of age, discharged directly to home, and have postoperative stays between 1-5 days. This study went through the proper IRB channels utilizing a waiver of informed consent. The variables of interest were patient postoperative lengths of study, and the outcome of interest was postoperative readmission within 30 days. Additional variables noted were patient demographics, comorbidities, and type of ostomy surgery. There was a bivariate analysis comparing the patients who had expeditied discharges vs those with nonexpeditied discharges – this led to a multivariable logistic regression model due to the additional factors previously mentioned.
Discuss the limitations of the article: limited sample size, design flaws and/ or author bias
ReplyDeleteSome limitations the article stated are as follows:
-Study cannot account for ostomy education received by patients
-Patients with non expedited length of stay were not assessed wether they are potentially eligible for expedited stay
-Patients social determinants of health
-Exact reason for surgery
-Unavailability of reasons for readmission.
-The database does not capture emergency department visits or other unplanned healthcare visits that may be necessary for hospital readmission.
What are the advantages and disadvantages of to the proposed recommendations in the article?
-The study emphasizes the importance of taking into account as to which patients may be eligible for an expedited discharge and creation of ostomy care training for these patients.The study recommends that future ostomy education protocols should become more standardized with inpatient/ outpatient resources tailored to expedited discharge pathways. Preventing risk of readmission after ostomy surgery can be done with proposer training and education.
Describe the method used.
ReplyDeleteThis was a retrospective review of data from 2019 to 2020. The information was taken from the ACSNSQIP which is a quality improvement project. The 13,628 patients in this study were all 18 years old or older, discharged home, and had a hospital length of stay between 1 to 5 days. A comparison was made between the expedited discharged patients (1-2 days) versus the non-expedited discharged patients (3-5 days). The study looked at weather the expedited or non-expedited patients would have higher readmission rates.
What are the advantages and disadvantages of the proposed recommendations in the article?
This study found no difference in re-admissions when comparing expedited versus non-expedited patients. An advantages to early discharge would be less risk of a nasocomial infection, possibly better quality of sleep at home, possibly greater comfort at home, and freeing up a hospital bed for another patient to be admitted. Disadvantages to early discharge would be less time for the wound care nurse and bedside nurse to properly educate the patient about ostomy bag emptying and changing, risk of dehydration, and peri-stomal skin complications. At PSJMC the wound ostomy nurses do not usually work on the weekends so the patient would miss out on that educational teaching if they did not get it beforehand and were discharged on a weekend.